Evaluating spillover of HIV knowledge from study participants to their network members in a stepped-wedge behavioural intervention in Tanzania.

OBJECTIVES: We aim to describe the social network members of participants of a behavioural intervention, and examine how the effects of the intervention may spillover among network members. DESIGN: Secondary analysis of a step-wedge randomised controlled trial. SETTING: Change agents (CAs) were recruited from waiting rooms of HIV treatment facilities in Dar es Salaam, Tanzania, and their network members (NMs) were recruited directly by CAs. PARTICIPANTS: We enrolled 662 CAs in an HIV behavioural intervention. They, along with 710 of their NMs, completed baseline and follow-up interviews from 2011 to 2013. PRIMARY AND SECONDARY OUTCOMES: The primary outcome of this study was change in NMs' HIV knowledge, and the secondary outcome was whether the NM was lost to follow-up. RESULTS: At baseline, many characteristics were different between NMs and CAs. We found a number of NM characteristics significantly associated with follow-up of NMs, particularly female gender (OR=1.64, 95% CI: 1.02 to 2.63) and HIV knowledge (OR=20.0, 95% CI: 3.70 to 125); only one CA variable was significantly associated with NM follow-up: having a private source of water (OR=2.17, 95% CI: 1.33 to 3.57). The 14.2% increase in NMs' HIV knowledge was largely due to CAs feeling empowered to pass on prior knowledge, rather than transmitting new knowledge to their NMs. CONCLUSIONS: Characteristics of social network members of persons living with HIV persons living with HIV may play a role in study retention. Additionally, the HIV knowledge of these NMs increased largely as a function of CA participation in the intervention, suggesting that intervening among highly-connected individuals may maximise benefits to the potential population for whom spillover can occur. TRIAL REGISTRATION NUMBER: Clinical Trial: NCT01693458; Post-results

Agents of change: Comparing HIV-related risk behavior of people attending ART clinics in Dar es Salaam with members of their social networks.

The aim of the study is to compare sociodemographic characteristics, psychosocial factors, HIV knowledge and risk behaviors of people living with HIV (PLH) and their social network members (NMs) to inform HIV prevention programs that engage PLH as prevention educators in their communities. We compared baseline characteristics of PLH enrolled in an intervention to become HIV prevention Change Agents (CAs) (n = 458) and 602 NMs they recruited. CAs and NMs responded to questionnaires through a computer-driven interface with Audio Computer-Assisted Self Interview (ACASI) software. Although NMs scored higher on socio-economic status, self-esteem and general self-efficacy, they had lower HIV knowledge (AOR 1.5; 95% CI: 1.1-2.1), greater inconsistent condom use (AOR 3.2; 95% CI: 2.4-4.9), and recent experience as perpetrators of physical (AOR 2.5; 95% CI: 1.2-5.1) or sexual (AOR 4.1; 95% CI: 1.4-12.7) intimate partner violence; and as victims of physical (AOR 1.5; 95% CI: 1.0-2.3) or sexual (AOR 2.2; 95% CI: 1.3-3.8) forms of violence than CAs. Higher HIV knowledge and lower sexual risk behaviors among CAs suggest PLH's potential as communicators of HIV prevention information to NMs. CAs' training should also focus on improving self-esteem, general self-efficacy and social support to increase their potential effectiveness as HIV prevention educators and enhance their own overall health and well-being

Agents of change among people living with HIV and their social networks: stepped-wedge randomised controlled trial of the NAMWEZA intervention in Dar es Salaam, Tanzania.

INTRODUCTION: NAMWEZA is a novel intervention that focuses on preventing HIV and promoting sexual and reproductive health and rights by addressing underlying factors related to vulnerability of acquiring HIV, such as depression, intimate partner violence (IPV) and stigma. The goal of the study was to evaluate the effect of the NAMWEZA intervention on risk behaviour as well as factors potentially contributing to this vulnerability for people living with HIV and their network members. METHODS: A stepped-wedge randomised controlled trial was conducted from November 2010 to January 2014 among people living with HIV and their network members in Dar es Salaam, Tanzania. 458 people living with HIV were randomised within age/sex-specific strata to participate in the NAMWEZA intervention at three points in time. In addition, 602 members of their social networks completed the baseline interview. Intention-to-treat analysis was performed, including primary outcomes of uptake of HIV services, self-efficacy, self-esteem, HIV risk behaviour and IPV. RESULTS: For people living with HIV, a number of outcomes improved with the NAMWEZA intervention, including higher self-efficacy and related factors, as well as lower levels of depression and stigma. IPV reduced by 40% among women. Although reductions in HIV risk behaviour were not observed, an increase in access to HIV treatment was reported for network members (72% vs 94%, p=0.002). CONCLUSION: These results demonstrate the complexity of behavioural interventions in reducing the vulnerability of acquiring HIV, since it is possible to observe a broad range of different outcomes. This study indicates the importance of formally evaluating interventions so that policymakers can build on evidence-based approaches to advance the effectiveness of HIV prevention interventions. TRIAL REGISTRATION NUMBER: NCT01693458

The role of emotions in the choice to adopt, or resist, innovations by Irish dairy farmers

In this paper we uncover the emotional factors that contribute to the adoption, or rejection, of different categories of innovation by dairy farmers in Munster, Republic of Ireland. Although emotions have been extensively researched in different fields, little research to date has examined the effects of emotions on farmers' decision making. Munster is the most important region for grass-based dairy farming in Ireland and this type of farming still plays an important role in Ireland's economy and sense of self. By using in-depth interview data from 27 dairy farmers and 6 other participants in the local industry we identified three categories of innovation that were influenced by different emotional pathways. We further uncovered the strong value-driven emotions that underpin the Irish dairy farmers' beliefs about what farming is, and means, and the influence that this has on innovation choices

Writing settlement after Idle No More: non-indigenous responses in Anglo-Canadian poetry

This article examines the representation of settlement in Canada in the wake of Idle No More in recent Anglo-Canadian literature. It argues that Idle No More engendered a new vocabulary for settler-invader citizens to position themselves in relation to this Indigenous movement, with non-Indigenous Canadians self-identifying as “settlers” and “allies” as a means of both orienting themselves with respect to Indigenous resistance to the settler-invader nation-state and signalling an attempted solidarity with Idle No More that would not lapse into appropriation. Four very different poetic texts by non-Indigenous authors demonstrate this reconsideration of settlement in the wake of Idle No More: Arleen Paré’s Lake of Two Mountains (2014); Rachel Zolf’s Janey’s Arcadia (2014); Rita Wong’s undercurrent (2015); and Shane Rhodes’s X (2013). Although only the latter two of these collections make explicit reference to Idle No More, all four of these texts engage with historical and current colonialisms, relationships to land and water, and relationships between Indigenous peoples and settler-invaders, providing examples of new understandings and representations of (neo)colonial settlement in post-Idle No More Canada

Idle No More: Freedom in an Era of Climate Change

Idle No More has quickly become one of the largest Indigenous mass movements in Canadian history – sparking hundreds of teach-ins, rallies, and protests across Turtle Island and beyond. It has also brought together a number of solidarity groups and allies looking to work against the current and pending governmental policy that impacts on collective rights, social safety nets, and environ- mental protections. The impetus for the Idle No More events, lies in a centuries old resistance as Indigenous nations and their lands suffered the impacts of exploration, invasion and colonization. Idle No More seeks to assert Indigenous inherent rights to sovereignty and reinstitute traditional laws and Nation to Nation Treaties by protecting the lands and waters from corporate destruction. Each day that Indigenous rights are not honored or fulfilled, inequality between Indigenous peoples and the settler society grows. Idle No More continues to educate and inform all peoples of the continued colonial impacts to lands and resources. About the Lecturer: Sylvia McAdam (Saysewahum) is from the Treaty 6 lands in what is now called “Canada”. She is a direct descendant of Treaty peoples. Sylvia is nēhīyaw and nakawe and speaks fluently in nēhīyaw. Sylvia has her Juris Doctorate from the University of Saskatchewan and a Bachelor’s degree in Human Justice from the University of Regina. Sylvia is co-founder of a global grassroots Indigenous led movement called ‘Idle No More’. Idle No More has changed the political and social landscape of Canada as well as reached the global community to defend and protect all lands and water from devastation. Through the work of protecting land and water, Sylvia has been selected for several awards namely; Carole Gellar Human Rights Award, Foreign Policy Top 100 Global Thinkers 2014, Social Justice Award, and 2014 Global Citizen Award

Crossing visual borders and connecting cultures: children’s responses to the photographic theme in David Wiesner’s 'Flotsam'

<i>Flotsam</i> (2006), the award-winning wordless picturebook by David Wiesner is about the power and mystery of photographs but, at the same time, it plays with many of the techniques of photography to tell its story. This article discusses these themes and techniques and also examines children’s responses to the picturebook, both oral and photographic. It considers photography with children as a research tool for investigating identity, culture, and literacy. The discussion about <i>Flotsam</i> and the photographs provided an insight into children’s understanding, not only of wordless narrative but also of the techniques and uses of photography. We argue that the photographs increase the children’s control of the way in which their space, as well as their identity, is represented to others; a representation that is particularly important for immigrant pupils. We conclude that Flotsam can act as an incentive to reflect on the idea of looking carefully; to think about artistically complex texts and about the potential of photography. Finally, we suggest that photography is a promising way of exploring the visual image, not only from an investigative but also from a pedagogic point of view, as it can draw attention to the construction and metalanguage of image and thus strengthening comprehension and critical literacy skills